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Original Article

Evaluation of dent-o-myths among adult population

living in a rural region of Andhra Pradesh, India:
Across-sectional study
Ghanta Bhanu Kiran, Srinivas Pachava, Suresh Sanikommu, Bommireddy Vikram Simha,
RavuriSrinivas, Vinnakota Narayana Rao
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India

ABSTRACT
Context: Even though dentistry is one of the very highly developed fields among the medical sciences, false traditional beliefs and
nonscientific knowledge may seed myths that create hindrance in the recognition of scientific and modern dental treatments, thereby
acting as a barrier against the utilization of oral health-care facilities.
Aims: The present study was an attempt to evaluate various dental myths prevailing in a rural population.
Settings and Design: The study sample comprised of 305 subjects aged 18 years and above, acquired from six randomly chosen
villages of Guntur district in Andhra Pradesh, India.
Materials and Methods: A cross-sectional questionnaire survey was carried out to assess the various dental myths.
Statistical Analysis Used: The data were analyzed using chi-square and multinomial logistic regression tests in SPSS version 20.
Results: The mean age of the study population was 38.03 15.15 years, 57.4% of whom were males and 42.6% females. Of the
subjects, 58.7% felt that deciduous teeth did not need any treatment procedures as they would be exfoliated anyway; 40% of those
who had never visited a dentist before felt that extraction of the upper teeth affected eye vision. Of individuals aged 18-39 years,
47.6% believed that cleaning with salt made teeth white and shiny. Only a few (3.9%) believed absolutely no dental myths, whereas
most (96.1%) believed one myth or another.
Conclusions: The results of this study revealed that dental myths are still prevalent and that they need to be addressed to achieve
optimal dental health.

Key words: Dental myths, false traditional beliefs, nonscientific knowledge, oral misconceptions, taboos

INTRODUCTION developing countries.[1] For any country to advance,

health care should always be among the top-priorities.
Oral diseases make significant contributions to the India is now among the top three countries in the
global burden of disease, which is particularly high production of scientific manpower. For a population
in the underprivileged groups of both developed and of over 1.2 billion, there are currently over 1,80,000
dentists and the number is expected to grow to
Address for correspondence: 3,00,000 by 2018.[2] The dentist-to-population ratio in
Dr. Ghanta Bhanu Kiran, Department of Public Health
Dentistry, SIBAR Institute of Dental Sciences, Takkellapadu, This is an open access article distributed under the terms of the
Guntur-522509, Andhra Pradesh, India. Creative Commons Attribution-NonCommercial-ShareAlike 3.0
E-mail: bhanukiranghanta@gmail.com License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
Access this article online new creations are licensed under the identical terms.
Quick Response Code:
Website:
For reprints contact: reprints@medknow.com
www.jdrntruhs.org
How to cite this article: Kiran GB, Pachava S, Sanikommu S, SimhaBV,
DOI: Srinivas R, Rao VN. Evaluation of dent-o-myths among adult population
living in a rural region of Andhra Pradesh, India: A cross-sectional study.
10.4103/2277-8632.185451
J NTR Univ Health Sci 2016;5:130-6.

130 2016 Journal of Dr. NTR University of Health Sciences | Published by Wolters Kluwer - Medknow
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Kiran, et al.: Knowledge about dental myths
India as mentioned in a report by the Central Bureau
of Health Intelligence was 1:10,271 in 2011.[3] While
the World Health Organization (WHO) recommends a
dentist-to-population ratio of 1:7500, there are some
states in India with a dentist-to-population ratio as
high as 1:5000. Even with all these improvements
in numbers, the prevalence of oral diseases in India
is still high.[4] The prevalence is particularly high in
rural areas due to underutilization of dental services
available in rural areas and the accretion of dentists
in urban areas.
Culture is often defined as coherent, shared patterns
of actions or beliefs specific to named groups of
people that provide basic life roadmaps or social
contexts, defining behavioral norms and interpersonal
relationships as well as unwritten rules for proper
living. [5] Culture has its own influence on health
and sickness. The influence of culture is seen in
every discipline of health and medical practices, and
dentistry is no exception. Society and culture, which
are linked to behavioral patterns, largely influence
the health outcomes of a population. Information on
the status of oral health of the different populations
in the USA, North Africa, and Asia suggests that
people from specific ethnic minorities often have
poor oral health status. [5,6] Being part of an ethnic
minority group does not inevitably lead a person to
have poor oral health. Underlying cultural beliefs and
practices influence the conditions of the teeth and
mouth, through diet, care-seeking behavior, or use of
home remedies. It does suggest that there are certain
cultural beliefs and practices common to people that
influence their dental service utilization and oral
health status.[5,6] In India, a country of diverse ethnic
groups, geographical character, cultures, and religions,
there is a need to explore the influence of social
factors on oral health.
Sociocultural factors, false traditional beliefs, lack of
proper education, and nonscientific knowledge may
seed dental myths.[7,8] Furthermore, it is no myth that
dental work can be frightening sometimes. With so
much unnecessary stress and anxiety built up around
dentists and dental health, it is not surprising that
several myths were made up over the years to help
explain or even alleviate dental issues. Often, people
choose to believe these myths rather than finding out
the truth and, after a while, the myths can become so
ingrained in their respective cultures that it is hard to
tell fact from fiction.
Journal of Dr. NTR University of Health Sciences 2016;5(2)
Dental health-related disbeliefs and misconceptions,
when handed down from one generation to next,
can be called dental myths. To have such beliefs
indicates an acceptance that something exists or is
true, especially one without proof. A misconception
is defined as a belief or an idea that is not based
on correct information. Myths are defined as stories
shared by a group of people that are part of their
cultural identity. They have a strong influence on
the life of individuals and their way of living,
including seeking treatment during illness.[9,10] Myths
and misconceptions are present in all cultures,
all professions, and on all subject matters. While
some dental myths are provincial, others are heard
everywhere. A close look at tales about deciduous
teeth that exfoliate gives an idea of how myths vary
from one region to another.
The tooth fairy is a character in modern Western
culture said to give children a small gift in
exchange for a deciduous tooth when it comes out
of a childs mouth. Years ago in Europe, children
threw lost teeth in mouse holes, hoping that they
would grow sharp teeth. In northern Europe, there
was a tradition of a tooth fee, which was paid
when a child lost his/her first tooth.[11,12]
Children in Asian countries such as India, China,
Japan, Korea, and Vietnam toss their lower teeth
on the roof and bury their upper teeth in the
ground, trusting that the new teeth will grow
toward the old teeth and be straight.[11,13]
In Middle Eastern countries including Iraq,
Jordan, Palestine, Egypt, and Sudan, there is a
tradition of throwing a baby tooth up into the sky
toward the sun or to Allah.[11,13]
Although modern dentistry has come a long way
and evidence-based dentistry is on the rise, most
people still have some preconceived, false notions
about dental care. These preconceived false notions
or dental myths can at times be detrimental and
result in various degrees of disability. Dental myths
thus need to be tackled to facilitate the appropriate
utilization of dental services and restrict disability to
the bud stage. A study conducted in a North Indian
rural population reported 81% prevalence of one or
more dental myths,[14] and a 95.2% prevalence was
reported in another study in Karnataka.[15] Comparable
studies were also conducted in Uttar Pradesh and
Tamil Nadu.[16-18] Exploration of the available literature
related to myths about dentistry revealed hardly any
data from Andhra Pradesh, though myths related to
131
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Kiran, et al.: Knowledge about dental myths
oral diseases and oral health-related practices are very
common in the rural population of India, The current
study was done to evaluate various dental myths that
prevail in a rural population residing in a coastal area
of a southern Indian state, Andhra Pradesh.
MATERIALS AND METHODS
A cross-sectional study was conducted on adults aged
18 years and above using a schedule, in six villages
randomly selected from among the 13 villages in
Pedakakani Mandal, Guntur. Guntur is a district in
the Indian state of Andhra Pradesh, on the eastern
coast of the Bay of Bengal. It covers an area of
11,391 km 2 and is divided into 57 administrative
areas.[19] As per the 2011 census, the total population
of Pedakakani Mandal was approximately 64,693,
the male population being approximately 32,779.[20]
The current study was approved by the Institutional
Ethics Board of the Sibar Institute of Dental Sciences,
Guntur. The inclusion criterion included subjects who
were above 18 years of age and who were continuous
residents of that particular village for at least 10
years. The study procedure was explained to villagers,
and those unwilling to participate in the study were
excluded. Informed consent in verbal form was
accepted as adequate by the Ethical Review Board.
To begin with, a pilot study was done on
30individuals to find out the prevalence of dental
myths and to test the reliability and validity of the
schedule. Internal consistency was estimated via
Kuder-Richardson Formula 20 and it was satisfactory.
The prevalence obtained was used for sample size
calculation, and informed verbal consent was taken
from all the 305 individuals randomly selected
from the six villages included in the study. All the
randomization procedures in this multistage sampling
were of the nonreplacement type. Review of the
literature that was available on dental myths and the
experiences that we had while dealing with patients
in this region of India were helpful in preparing
the schedule. The questionnaire was prepared in the
English language first and later translated to Telugu
(the local language). The Telugu version was later
translated back into English and checked for language
reliability and content validity. The questionnaire
was self-designed and authenticated for validity and
reliability during the pilot study (kappa coefficient
value = 0.82; P value = 0.002). The first part of the
schedule included information about demographic data
132
and the second part was a questionnaire on dental
myths. About 16 myths were studied in total, and
the responses were recorded on a dichotomous scale.
Data were collected through a schedule instead of by
mailing the pretested questionnaire, to overcome the
hurdle of illiteracy, and the study procedure continued
for a period of 3 months in 2014.
The level of knowledge on the subject of dental
myths was graded as low knowledge (respondents
with 11-16 myths), medium knowledge
(respondentswith 6-10 myths), good knowledge
(respondents with 1-5 myths), and excellent
knowledge (subjects with no myths). Chi-square test
and multinomial logistic regression analysis were
used for statistical comparisons and P 0.05 was
considered statistically significant. The data were
analyzed using SPSS version 20.0 (Armonk, IBM
Corp., NY).
RESULTS
The study population had a mean age of 38.03
15.15 years, and 57.4% consisted of males and
42.6% of females. This male/female ratio in the
present study contradicted that of the 2011 census
in this region, which can be attributed to the fact
that more females were reluctant to participate in
the study when compared to males. Out of the
total sample, only 42.6% (n = 130) of subjects had
visited the dentist at least once in their lifetime.
Not many individuals (n = 17) in this study had
higher education, as the study was done in rural
areas [Table 1]. Individuals aged 18 years and
above were included in the study and the percentage
distribution by age was 62% (18-39 years), 32.1%
(40-64 years), and 5.9% (>64 years). The inclination
of population distribution percentage was similar to
that given by the government of India in the 2011
census. Regarding professions, 36% of the study
population were farmers/small-shop-owners; 33%
were unskilled/semiskilled/skilled workers; 27%
were unemployed; and 4% were semi-professionals/
TABLE 1: DISTRIBUTION OF RESPONDENTS BASED
ON EDUCATIONAL STATUS
Education Frequency Percent (%)
Illiterate 87 28.5
1st to 7th grade education 86 28.2
8th grade to pregraduation course 115 37.7
Graduation and above 17 5.6
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Kiran, et al.: Knowledge about dental myths

professionals. Ofthe study population, 70% had a
family income of 4810-12019 INR per month. The
education, income, and occupation were classified
based on the Kuppuswamy scale;[21] however, instead
of the family heads education and occupation, in
this study the participants data were collected. [22]
No attempt was made to calculate socioeconomic
status, as the study was focused on the sociocultural
dimension. Though socioeconomic status were not
intended to be measured, Kuppuswamy classification
criteria for education, occupation, and income levels
in rural areas were used, only to maintain a universal
standardization system. Limitations in the practical
use of socioeconomic scales[22] compelled us to take
this decision, moreover, to facilitate the comparison of
the present results with the results of similar studies
scheduled in urban areas in the near future.
That deciduous teeth do not need any treatment
procedures as they will be exfoliated anyway, was
the most prevalent myth (n = 179) found in the study.
Next was that 52.5% (n = 160) of the respondents
felt that cleaning with salt makes teeth white and
shiny. Of the subjects, 32.8% (n = 100) felt that
extraction of the upper teeth affects eye vision. When
the responses of males and females to various dental
myths were compared using the chi-square test, males
significantly outnumbered females for belief in the
myth that the use of twigs instead of toothbrushes is
effective for the maintenance of good oral hygiene
(P= 0.000) and that drinking alcohol will reduce
tooth pain (P = 0.000). A higher number of females
than males felt that having midline diastema or
anterior teeth malocclusion is lucky [P = 0.019,
Table2].
Those who had not visited a dentist at least once
till date believed more dental myths than did those
who had visited the dentist at least once, which
establishes that people with more dental myths are
less likely to utilize dental services. The health
education and awareness provided by a dentist to the
patient also might have influenced the distribution
pattern. Myths such as that drinking alcohol reduces
tooth pain (P=0.016); that the use of twigs instead
of toothbrushes will be effective for maintenance of
good oral hygiene (P = 0.003); that extraction of
upper teeth affects eye vision (P = 0.002); burying
exfoliated teeth or placing them in cow dung (P =
0.047); and that using tobacco or tobacco products as
a remedy for tooth pain is effective (P = 0.048) were
found significantly more in those who had not visited
a dentist at least once till date [Table 3].

TABLE 2: ASSOCIATION OF DENTAL MYTHS WITH GENDER

Dental myths Gender P value*
Male % (n) Female % (n)
Use of finger or twigs instead of toothbrush will be Present 44.6 (78) 21.5 (28) 0.000
effective for maintenance of good oral hygiene Absent 55.4 (97) 78.5 (102)
Having midline diastema or front Present 14.9 (26) 26.2 (34) 0.019
teeth malocclusion is lucky Absent 85.1 (149) 73.8 (96)
Drinking alcohol will reduce tooth pain Present 21.7 (38) 1.5 (2) 0.000
Absent 78.3 (137) 98.5 (128)
*Statistical evaluation by means of chi-square (2) for differences between males and females. Only the myths that had P value 0.05 were tabulated

TABLE 3: ASSOCIATION OF DENTAL MYTHS WITH PREVIOUS DENTAL VISIT

Dental myths Previous dental visit P value*
Visited % (n) Not visited % (n)
Extraction of upper teeth affects eye vision Present 23.1 (30) 40 (70) 0.002
Absent 76.9 (100) 60 (105)
Exfoliated teeth should be buried or placed on the Present 13.8 (18) 22.9 (40) 0.047
roof of house or should be placed in cow dung Absent 86.2 (112) 77.1 (135)
Use of finger or twigs instead of toothbrush will be Present 25.4 (33) 41.7 (73) 0.003
effective for maintenance of good oral hygiene Absent 74.6 (97) 58.3 (102)
Using tobacco or tobacco products as a Present 26.9 (35) 37.7 (66) 0.048
remedy for tooth pain is effective Absent 73.1 (95) 62.3 (109)
Drinking alcohol will reduce tooth pain Present 7.7 (10) 17.1 (30) 0.016
Absent 92.3 (120) 82.9 (145)
*Statistical evaluation by means of chi-square (2) for differences between individuals who had visited a dentist previously and individuals who had not. Only
the myths that had P value 0.05 were tabulated

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Kiran, et al.: Knowledge about dental myths

Significant differences in positive responses were
found between various levels of educational status
for the dental myths that cleaning with salt makes
teeth white and shiny (P = 0.045), that removal of
milk teeth will lead to noneruption of permanent
teeth (P=0.012), and that tooth infections are
because of Gods curse (P = 0.028). Of subjects
aged 40-64 years, 63.3% felt that cleaning with salt
makes teeth white and shiny, which is statistically
significant (P=0.033) when compared to other age
groups. Of all the individuals who participated in
study, 2% (n= 6) had low knowledge about dental
myths, 20.3% (n = 62) had medium knowledge,
73.8% (n = 225) had good knowledge, and 3.9%
(n=12) had excellent knowledge. Bivariate analysis
of the distribution of different grades of knowledge
in the study subjects according to age groups, gender,
and previous dental visit revealed no significance
[Table4].
Males when compared to females were less likely
to have medium, good, or excellent knowledge than
TABLE 4: DISTRIBUTION OF LEVEL OF KNOWLEDGE
IN THE STUDY SUBJECTS ACCORDING TO AGE
GROUPS, GENDER, AND PREVIOUS DENTAL VISIT
Variables Levels of knowledge
Low Medium Good (%) Excellent value
poor knowledge. Similar results were produced
when illiterate subjects and educated subjects were
compared. Respondents who had not visited the
dentist previously when compared to those that had
visited at least once were less likely to have good or
excellent knowledge than low knowledge. However,
the differences that were found are not statistically
significant [Table 5].
DISCUSSION
Health belief theory states that dental health beliefs are
associated with dental health behaviors. Unfavorable
oral health beliefs are related to increased odds of
having poor self-rated oral health, increased risk of
gingivitis, high plaque score, and tooth loss due to
caries. Individuals with favorable dental beliefs tend
to have better oral health than those who do not,
particularly in terms of gingivitis, self-rated oral
health, and tooth loss due to dental caries.[23] Oral
hygiene practices may vary from one region to another
depending on local traditional beliefs. Myths such as
that using coal for cleaning teeth makes them strong,
that cleaning with salt makes teeth white and shiny,
and that the use of twigs instead of toothbrushes will
be effective for the maintenance of good oral hygiene,
P will have a negative effect on oral health as these are
*

not recommended oral hygiene practices. Though the

(%) (n) (%) (n) (n) (%) (n)
Age groups
extracts of many twigs/stems of plants have yielded
18-39 years 1.6 (3) 17.5 (33) 75.1 (142) 5.8 (11) 0.25 potent antimicrobial and antiplaque substances, the
40-64 years 3.1 (3) 24.5 (24) 71.4 (70) 1.0 (1) disadvantages include gingival trauma and occlusal
>64 years 0.0 (0) 27.8 (5) 72.2 (13) 0.0 (0) wear. Usage of coarse materials such as coal and salt
Gender in cleaning procedures could abrade the enamel and
Males 2.3 (4) 19.4 (34) 74.9 (131) 3.4 (6) 0.871
damage periodontal ligament.[16]
Females 1.5 (2) 21.5 (28) 72.3 (94) 4.6 (6)
Previous dental visit
Had not visited ever 2.3 (4) 22.3 (39) 71.4 (125) 4 (7) 0.73 Although deciduous teeth are not permanent, problems
Visited at least once 1.5 (2) 17.7 (23) 76.9 (100) 3.8 (5) in permanent teeth can develop in the long term if
*
Bivariate analysis was done using chi-square (2) test deciduous teeth are not properly cared for. Caregivers

TABLE 5: ASSOCIATION OF GENDER, EDUCATION, AND PREVIOUS DENTAL VISIT WITH LEVELS OF KNOWLEDGE
ABOUT MYTHS
Independent Levels of knowledge
variables Medium knowledge Good knowledge Excellent knowledge
Odds ratio (95% CI) P value *
Odds ratio (95% CI) P value *
Odds ratio (95% CI) P value*
Males 0.533(0.085-3.358) 0.503 0.651(0.109-3.896) 0.638 0.397(0.048-3.287) 0.392
Females 1 1 1
Illiterate 0.376(0.067-2.107) 0.266 0.393(0.075-2.057) 0.269 0.081(0.006-1.114) 0.060
Educated 1 1 1
Not visited 1.034(0.165-6.503) 0.971 0.735(0.124-4.366) 0.735 0.924(0.111-7.655) 0.941
Visited 1 1 1
Multinomial logistic regression analysis was performed keeping low knowledge as a reference category, P value should be 0.05 to be considered significant,
*

CI = Confidence interval

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Kiran, et al.: Knowledge about dental myths
of young children frequently feel that the first teeth
are not as important as the permanent teeth.[24,25] It is
crucial that children learn the basics of proper oral
hygiene at an early age. Doing so will help them
form permanent habits that are essential for oral
health. Furthermore, early loss of milk teeth will
interfere with chewing and affect the childs nutrition,
which leads to drifting of the adjacent teeth and
closure of some of the space that is required for the
succeeding permanent teeth to erupt into. Such a loss
of space will cause the permanent teeth to erupt in
irregular positions and result in crowding. Therefore,
milk teeth need to be cared for as much as permanent
teeth. It is advisable to start the habit of cleaning the
infants teeth soon after they appear in the mouth. In
fact, it is advised to clean a babys gum pads every
day by gentle massage even before the teeth erupt.[26]
Only 37.5% of the subjects considered the retention
of baby teeth to be important in a study by Saad
Ahmed Khan et al.[7]
Regarding another dental myth, 20% of subjects as
reported by Saravanan et al.,[17] 32.8% in the present
study, and 36.4% in a study done by Vignesh et al.[18]
felt that extraction of upper teeth affects eye vision.
One possible reason for the development of this myth
is that when an abscess develops from any of the
maxillary anterior teeth, the patient may sometimes
develop a large swelling under the eye leading to the
closing of that eye. Such a situation may lead to fear
that the eye is getting affected because of the tooth.
The other reason could be that people start losing
their teeth in middle age, which can coincide with
the period when people start to develop short sight
and are in need of glasses. This may have prompted
some to incorrectly come to the conclusion that the
extraction of upper teeth affects eye vision.
While scaling actually helps teeth to be more
strongly held by the surrounding gums and bone, and
promotes oral health, 24.6% of respondents in the
current study stated that professional scaling creates
sensitivity, mobility, and gaps between teeth; this is
in concordance with a myth among Hispanics/Latinos,
as found by Vazquez et al. [27] In addition, 63.2%
responded similarly in a study done by Vignesh
etal.,[18] and Tewari et al.[16] noted 82% prevalence of
a similar myth. The fact that the calculus would have
been filling the gaps, masking mobility and sensitivity,
and that only after removal of the calculus would the
underlying dentin be exposed, resulting in sensitivity
Journal of Dr. NTR University of Health Sciences 2016;5(2)
of teeth, should be emphasized along with the oral
prophylaxis procedure.
Professional dental cleanings can be performed at
any point during pregnancy. Emergency dental care
can also be performed at any time with physician
clearance. However, 21.3% of subjects in the current
study were of the opinion that dental treatments
should not be done during pregnancy, while 56.8%
were of that opinion in an earlier study by Vignesh
etal.[18] Awareness should be created regarding the
oral foci of infection, which when untreated can lead
to a baby with preterm low birth weight.
Dental myths were more marked in less educated
groups in the current study, analogous to what was
reported by Singh et al. and[14] Khan et al.[7] Males
had more myths, contradicting the outcome of a prior
study done by Singh et al.[14] where females had more
myths. In the current study 52.5% and in a study done
by Vignesh et al.[18] 56.8% felt that cleaning with salt
makes teeth white and shiny. In contrast, only 15%
felt so in the study done by Saravanan et al.[17] Apart
from the discussion on whether salt causes whitening
of teeth or not, this practice can definitely cause
abrasion of teeth, and dentinal sensitivity shoots up.
In contrast to the present study, bivariate analysis of
distribution of the level of knowledge about dental
myths in the study population with gender was found
to be significant in a study by Kanduluru etal.[28]
Only a small percent (3.9%) of the individuals are
absolutely without dental myths, whereas most of
them (96.1%) have one myth or the other. This
demonstrates a need for a health promotion program
in this area emphasizing scientific dental practices.
Limitations
1. The study design being cross-sectional and
observational could only unearth information
about the prevalence of dental myths. Further
studies in longitudinal design are required to
know the association of risk factors involved, to
completely eradicate myths.
2. Use of the Kuppuswamy classification criterion
for education, income, and occupation
3. Taking account of myths that are predominantly
observed in this region restricted our study to
one mandal. However, some myths that can be
generalized to all areas can be studied over a
large area.
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Kiran, et al.: Knowledge about dental myths
CONCLUSION
The present study shows that there is a need to
educate people more about the facts of dentistry.
The dentist should be aware of the various myths
about teeth prevailing in a particular area in order to
educate and provide correct information to patients.
The dentist should also maintain good rapport with
the patient so that the patient openly tells him/her
about his/her beliefs and gets a clearer idea. It is our
responsibility to debunk harmful dental myths and
promote the truth. Villages, which constitute a large
part of India, should be given due attention for dental
health education and awareness programs in an effort
to reduce the disparities between rural and urban
communities. In addition, measures to achieve equal
utilization of dental services in rural/urban localities
should also be taken by the government authorities.
Acknowledgment
We wish to thank all the participants in the study for
their cooperation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Journal of Dr. NTR University of Health Sciences 2016;5(2)